| NPI | 1518975093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 200140550RN) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OR 200250028NP) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2007-07-08 |